Transit Bipartition an Attractive Second-Step Option When Sleeve Gastrectomy Fails

By Reuters Staff

November 08, 2021

NEW YORK (Reuters Health) - For patients who fail to lose enough weight or regain weight after laparoscopic sleeve gastrectomy (LSG), revisional bariatric surgery in the form of transit bipartition is an attractive next step, say clinicians in Germany.

In Annals of Surgery Open, they note that "LSG has gained worldwide acceptance as first-line bariatric surgery for the treatment of morbid obesity. However, long-term results are variable with reported rates of primary failure or weight regain between 25% and 50% at five years depending on the definitions used."

Transit bipartition (TB) may be "an attractive RBS approach after LSG given the formidable weight reductions of 27% total weight loss at one year as a first-line intervention," say Dr. Markus Reiser with Klinikum-Vest GmbH, Paracelsus-klinik Marl, in Marl, and colleagues.

In their paper, they report outcomes in 100 morbidly obese patients (79 women) who underwent revisional TB for insufficient weight loss or weigh regain after LSG, with follow-up out to 12 months.

Mean BMI before LSG was 49.9 kg/m2 and decreased to a maximum of 32.7 kg/m2 at 22.1 months after LSG, corresponding to an excess-weight loss of 70.0%.

The mean time between LSG and TB was 52.2 months, at which time mean BMI had increased to 37.6 kg/m2, corresponding to 49.4% excess-weight loss.

Following TB, BMI decreased continuously to 31.4 kg/m2 after 12 months with a corresponding increase in excess-weight loss to74.7% and total weight loss reaching 36.3%.

However, the length of the common channel (CC) had a significant impact on TB results; after 12 months, weight loss was significantly greater for CC length of 250 cm versus 300 cm (BMI, 29.4 vs. 33.0 kg/m2, P=0.002; and excess-weight loss of 79.8% vs. 70.4%; P=0.009).

"Improvement of comorbidities was observed in a high proportion of patients. Major complications were observed in 3% of patients and managed without fatalities," the clinicians report.

In addition to weight loss, most patients saw improvement of obesity-related comorbidities such as arterial hypertension, obstructive sleep apnea and type-2 diabetes, as well as persisting or de novo symptoms of gastroesophageal reflux disease (GERD).

"Satisfaction regarding the combined endpoints of weight loss and improvement of reflux symptoms was high with 83% of patients reporting to be very or overall satisfied," the clinicians report.

A strength of this study is the large number of patients from a prospective registry, all of whom were followed up at 12 months.

A limitation is the descriptive design which does not allow direct comparison of TB to other RBS procedures. In addition, the 12-month follow-up is short, "leaving the confirmation of a sustained impact unanswered."

SOURCE: Annals of Surgery Open, online October 1, 2021.